Pramipexole

Key facts

• Pramipexole (brand name Mirapex) is a dopamine agonist. It mimics dopamine to treat the motor symptoms of Parkinson's disease and the leg discomfort of restless legs syndrome.
• Doses are usually started low and increased gradually; for restless legs syndrome it's often taken a few hours before bedtime.
• It can cause sudden, irresistible sleep attacks with no warning drowsiness beforehand, and it's linked to impulse-control disorders such as compulsive gambling, shopping, eating, or hypersexuality. Tell your prescriber immediately if you or your family notice these behaviours.
• Seek urgent care for fainting, chest pain, or a sudden inability to stay awake while driving.

What pramipexole treats

Pramipexole treats the tremor, stiffness and slowed movement of Parkinson's disease, and it treats restless legs syndrome, an urge to move the legs that's worse in the evening and at rest. It does not cure either condition; it manages symptoms.

How pramipexole works

Pramipexole binds to dopamine receptors in the brain, activating them the way the brain's own dopamine would. This helps offset the dopamine shortfall behind Parkinson's motor symptoms, and it calms the abnormal nerve signalling behind restless legs syndrome.

Before you take it

• Tell your doctor about low blood pressure, fainting spells, hallucinations, or kidney impairment, all of which change how pramipexole is dosed or monitored.
• Discuss any personal or family history of impulse-control problems, such as gambling or compulsive behaviour, before starting.
• Alcohol and other sedating medicines add to drowsiness and increase fall risk.
• Do not stop pramipexole suddenly, especially at higher Parkinson's doses. Stopping abruptly can cause fever, confusion and severe muscle stiffness.

Side effects

Common effects include nausea, dizziness, drowsiness, constipation, and swelling of the legs or ankles.

Seek urgent medical care for:

• Falling asleep suddenly during an activity such as driving, with no prior warning.
• New or worsening compulsive gambling, shopping, eating, or sexual behaviour.
• Fainting or severe dizziness on standing.
• Hallucinations, confusion, or agitation.

Safety essentials

• Pramipexole can cause sudden sleep attacks with no warning drowsiness beforehand. Avoid driving or operating machinery until you know how it affects you, and stop driving immediately if this ever happens.
• Tell your prescriber right away about new gambling, shopping, eating or sexual urges. These impulse-control problems usually improve when the dose is lowered or the drug is stopped.
• Never stop it abruptly. Your prescriber will taper the dose to avoid withdrawal symptoms or a rebound of symptoms.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.